AB0234 POTENTIAL CREDIBILITY IN RHEUMATOID ARTHRITIS PATIENT REPORTED DAS28 SCORES
Authors: S. Cabraal
Journal: Annals of the Rheumatic Diseases (2022)

Background Due to COVID-19 and the reduction of face to face clinic, the rheumatology telephone advice line service has been an integral part in identifying patients that need assessment the most (1). This however means relying on a patient’s ability to conduct their own disease activity score (DAS28), which clinicians conduct to help drive patients with rheumatoid arthritis (RA) into remission. Current literature suggests that patient self-assessed joint counts are reliable and when compared to the joint count of the physician, have an acceptable level of accuracy (2-5). We present data from an NHS audit where we incidentally found that patients could conduct their own joint counts. Objectives Our objective was to compare self-reported DAS28 scores with the clinical opinion of physicians during a face-to-face appointment. Methods We identified 10 patients with RA who attended a face-to-face appointment following a call to the helpline where a telephone DAS28 score was undertaken (with guidance from rheumatology specialist nurses). These scores were contrasted against the clinician’s assessment of whether synovitis was present or not in a face-to-face consultation. Co-morbidities: fibromyalgia (FM), osteoarthritis (OA) or both, were also recorded to examine whether these conditions influenced a patient’s ability to perform an accurate DAS28 score. Results There were 10 patient self-reported DAS 28 scores in total. 70% (7/10) of patients DAS 28 scores were over 4.01. In all these cases, clinicians confirmed evidence of synovitis during their face-to-face consultation. 30% (3/10) of patients self-reported DAS 28 score was &lt;4.01. Of these patients 2/3 have no evidence of synovitis according to their clinician. When considering co-morbidities, one individual also suffered from OA. This individual’s self-assessed DAS28 score was over 4.01 and was also evidenced to have synovitis during their consultation with the clinician. Figure 1. Shows patient’s self-assessment DAS28 scores and whether synovitis was identified following a face to face consultation with a clinician. Conclusion This regional NHS audit found that patients who self-reported DAS28 scores over 4.01 accurately identified a flare up, as confirmed by a diagnosis of synovitis at a face-to-face appointment. This is significant as it demonstrates that patients who score above 4.01, can reliably assess their own joint count. This may enable the Rheumatology service to become more patient-driven, empowering patients to accurately assess their condition. References [1]Wales, G., 2021. Age friendly Wales: our strategy for an ageing society. [online] GOV.WALES. Available at: &lt; https://gov.wales/age-friendly-wales-our-strategy-ageing-society-html &gt; [Accessed 30 January 2022]. [2]Abraham N, Blackmon D, Jackson J, Bradley L, Lorish C, Alarcón G. Use of self - administered joint counts in the evaluation of rheumatoid arthritis patients. Arthritis Care Res (Hoboken). 1993;6(2):78-81. doi:10.1002/art.1790060206 [3]ML P, IH K, MA t, MA v, LB v, PL v. Validity and reproducibility of self-administered joint counts. A prospective longitudinal followup study in patients with rheumatoid arthritis. PubMed. https://pubmed.ncbi.nlm.nih.gov/8724295/ . Published 1996. Accessed January 27, 2022. [4]AL W, WK W, J H et al. Patient self-report tender and swollen joint counts in early rheumatoid arthritis. Western Consortium of Practicing Rheumatologists. PubMed. https://pubmed.ncbi.nlm.nih.gov/10606362/ . Published 1999. Accessed January 27, 2022. [5]Inderjeeth C, Inderjeeth A, Raymond W. A multicentre observational study comparing patient reported outcomes to assess reliability of swollen and tender joint assessments and response to certolizumab treatment as compared to clinician assessments in rheumatoid arthritis. Int J Rheum Dis. 2018;22(1):73-80. doi:10.1111/1756-185x.13364 Disclosure of Interests None declared